Doctor-patient communication,associated factors and needs among children with cancer aged 8-15 years at the Uganda Cancer Institute
Background: The burden of cancer in children is increasing worldwide including Uganda. Communication with paediatric cancer patients is complex and entails at least a triad; the patient, parent/caregiver and provider, suggesting the need for providers to be competent about the concerns of the patients and their caregivers. However, communication is inclined to caregivers. As providers of paediatric cancer services, doctors are expected to provide holistic care including effective communication. Good communication and patient involvement are critical in cancer care and lead to more patient satisfaction, adherence to treatment and good health outcome. There is a need to document doctor-patient communication, associated factors and needs among paediatric cancer patients in a resource-limited setting in order to improve patient management. Objective: To describe doctor-patient communication, associated factors and needs among children with cancer aged 8- 15 years at the Uganda Cancer Institute (UCI). Methodology: The study was a descriptive cross-sectional design, involving the use of quantitative and qualitative data collection methods. It was conducted at the UCI among children with cancer aged 8 – 15 years attending the Paediatric outpatient (OPD) clinic. A total of 109 participants were recruited. Informed assent and consent were sought from the children and their caregivers respectively. Data for the independent variables was collected using interview schedules with both open-ended and closed-ended questions. The adapted MPI tool with three scales was used to assess satisfactory doctor-patient communication (mean score of 2.34 -3.00). For the qualitative data, in-depth interviews were conducted with 14 children and 7 doctors as key informant interview. Logistics regression was used to analyse the quantitative data while the qualitative data was transcribed and analyzed manually using the content thematic approach. Results: The mean age of participants in years (SD) was 12 ±2. The majority of participants 66/109 (60.6%) were females. More than half of the participants 62/109 (56.9%) had either leukaemia or lymphoma. Satisfactory doctor-patient communication was reported in 45/109 (41.3%); CI: 32.3, 50.9. The communication needs regarding the process of communicating with the children diagnosed with cancer included; need to be encouraged to ask questions, be given much information concerning their illness and checking for understanding. The communication needs regarding the content included; treatment and prognosis related concerns; school, family and play while fear of death and relapse were the most common fears reported by the participants. The vi factors significantly associated with satisfactory doctor-patient communication were; the child’s education level/class (AOR=4.51, 95% CI: 1.78, 11.36, p= 0.001), combined therapy (AOR= 5.97, 95% CI: 1.79, 19.88, P= 0.004) and patient knowledge of treatment benefits (AOR= 4.81, 95% CI: 1.63, 14.21, p= 0.004). The culture of children not speaking freely with adults negatively influenced the doctor-patient communication while holding independent child sessions, doctor’s communication skills and continuity of care were key facilitators. Conclusion and recommendation: Doctor-patient communication among children with cancer at the UCI was found to be critical but unsatisfactorily low. The communication needs of children with cancer in this study did not differ from those reported in high-income settings. The doctors providing care to children diagnosed with cancer at the UCI should be trained in better communication skills with particular attention paid to process communication skills and understanding the patient’s perspective of the illness in order to improve care and management of children with cancer.